Abstract The widespread successful implementation
of evidence-based practices (EBPs) into community
mental health settings will require a thorough under-
standing of practitioner attitudes toward these ap-
proaches. This study reports on the results of two
community mental health practitioner focus groups
investigating attitudes toward EBPs, perceived chal-
lenges to implementing EBPs, and recommendations
for researchers interested in facilitating EBP use in
community settings. The participants were child and
adolescent mental health professionals (N=19) from
two community mental health centers. The focus
groups were taped, transcribed and coded for themes.
Major themes included concerns regarding the appli-
cability of some research supporting EBPs, a desire for
a greater emphasis on the therapeutic relationship, and
the need for flexibility within treatment protocols.
Themes are discussed within the context of the recent
movement toward implementing EBPs in community
settings and recent research related to focus group
themes.
Keywords Evidence-based practice Æ Practitioner
attitudes Æ Community mental health centers Æ Focus
groups Æ Qualitative analysis
In recent years, government agencies, professional
organizations, and individual authors have called for
increased use of evidence-based practices (EBPs) in
clinical settings. In 2003, the President’s New Freedom
Commission on Mental Health released its report on
mental health services in the United States and iden-
tified the movement of EBPs into clinical settings as a
national priority (New Freedom Commission on
Mental Health, 2003). Similarly, the American Psy-
chological Association (APA) has recently approved a
policy statement regarding evidence-based treatments
(APA, 2005). Although the APA policy statement
does not embrace EBPs as unequivocally as the New
Freedom Commission report, it does acknowledge
the importance of evidence-based approaches in clini-
cal practice and contributes to the recent shift toward
EBPs.
In addition to the New Freedom Commission report
and the APA policy statement, other influential orga-
nizations and individuals have advocated for the use of
EBPs in the area of clinical child psychology. For
example, special editions of the Journal of Clinical
Child Psychology (i.e., Volume 27, Number 2) and the
Journal of Pediatric Psychology (i.e., Volume 25,
Number 4) have focused on evidence-based ap-
proaches for children and adolescents with a variety of
disorders. Likewise, APA’s Division 53 (Society for
Clinical Child and Adolescent Psychology) has created
a website for information on EBPs for children and
adolescents. Numerous authors have supported the
notion that EBPs should be adopted in clinical practice
with children, and some have questioned the ethics of
using treatments that lack research backing (Ollendick
& Davis, 2004).
Despite a general movement toward the adoption of
EBPs in clinical settings, many in the mental health
field have resisted the implementation of EBPs. In the
area of clinical child psychology, substantial evidence
T. D. Nelson (&) Æ R. G. Steele Æ J. A. Mize
2006 Dole Human Development Center, University of
Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555,
USA
e-mail: tdnelson@ku.edu
Adm Policy Ment Health & Ment Health Serv Res (2006) 33:398–409
DOI 10.1007/s10488-006-0044-4
123
ORIGINAL PAPER
Practitioner Attitudes Toward Evidence-based Practice:
Themes and Challenges
Timothy D. Nelson Æ Ric G. Steele Æ Jennifer A. Mize
Published online: 20 April 2006

Springer Science+Business Media, Inc. 2006

for the efficacy of numerous psychotherapeutic inter-
ventions has accumulated in recent years (Kazdin &
Weisz, 2003). However, advances in the quantity and
quality of such research have not led to widespread use
of treatments with empirical support (Connor-Smith &
Weisz, 2003; Hoagwood & Olin, 2002; Kazdin, 1997;
New Freedom Commission on Mental Health, 2003).
Even when EBPs make their way into clinical settings,
the transition from the laboratory to regular clinical
practice is typically a slow one, often taking 15–
20 years (Balas & Boren, 2000, as cited in the New
Freedom Commission on Mental Health, 2003).
One reason for the lack of widespread use of EBPs
in clinical settings has been the considerable resistance
encountered on the part of some practitioners. In 1995,
the APA’s Division 12 Task Force on Promotion and
Dissemination of Psychological procedures and the
Task Force on Psychological Interventions, released
their controversial guidelines for identifying treatments
with the best empirical support, and subsequent pub-
lications listed treatments with high levels of empirical
support (Chambless & Hollon, 1998; Chambless &
Ollendick, 2001; Chambless et al., 1996). Vocal oppo-
nents of this approach challenged the emphasis on
treatments with research support, claiming that psy-
chotherapy research does not address the issues that
are important to practitioners in the field (e.g., Gar-
field, 1996; Persons & Silberschatz, 1998; Strupp,
2001;). More recently, some authors have questioned
the assumption that treatment decisions should be
primarily based on research findings, instead suggest-
ing clinical judgment is a more appropriate basis for
clinical practice (e.g., Levant, 2004).
It is unclear whether the objections to the EBP
movement reflect the views of most clinicians or just a
vocal minority. As the field moves toward EBP, the
attitudes of practitioners in applied settings will play an
important role in the success of implementation efforts.
Therefore, understanding practitioner attitudes toward
EBPs, perceived challenges to implementing EBPs,
and recommendations for facilitating EBP implemen-
tation will be crucial to the successful movement of
EBPs into clinical settings.
In recent years, some research has begun to examine
practitioner attitudes toward EBPs. Aarons (2004)
studied practitioner attitudes toward EBPs in general,
surveying 322 public sector service providers working
with children, adolescents and families. Practitioners
reported a wide range of attitudes toward EBPs with
significant differences based on educational status
(higher educational status was associated with more
favorable attitudes), experience (greater experience
was associated with less favorable attitudes), and
setting (practitioners in inpatient settings were more
open to EBPs than those in outpatient settings). Addis
and Krasnow (2000) investigated practitioner attitudes
toward treatment manuals, a specific component
common to many EBPs, surveying a national sample of
891 practitioners. Similar to Aarons (2004), Addis and
Krasnow found considerable variance in practitioner
knowledge regarding and attitudes toward treatment
manuals.
While the Aarons (2004) and Addis and Krasnow
(2000) studies provide rare and valuable investiga-
tions of practitioner attitudes toward EBPs, the
present study aims to further explore this issue using
a focus group methodology to allow practitioners an
opportunity to articulate their attitudes toward EBPs
and related issues. Focus groups provide a more
open format for data collection than surveys, allow-
ing practitioners to identify important themes and
allowing researchers to capture the complexity of
practitioner perspectives. Therefore, we believe the
data collected from the present study will comple-
ment earlier survey research and help identify
important areas of considerations for the implemen-
tation of EBPs in clinical settings.
Method
Participants
Participants were 19 clinicians working full time in
one of two community mental health centers
(CMHCs) in a medium-sized Midwestern state. The
CMHCs were selected based on convenience and
their proximity to the authors. Each center is the
only CMHC in its county. Compared to the other 27
CMHCs in the state, the two centers included in this
study are located in more urban areas. Participants
worked primarily with children, adolescents and
families, providing either outpatient or community-
based mental health services. The present sample
consisted of 12 Masters-Level Licensed Social
Workers, 4 Ph.D.-Level Licensed Clinical Psycholo-
gists, 2 Masters-Level Licensed Psychologists, and an
Advanced Registered Nurse Practitioner (ARNP).
The total sample comprised approximately 51% (19
of 37) of the eligible clinicians at the targeted com-
munity mental health centers. The participants in
each focus group were generally representative of the
clinicians working in the child and family department
of their center based on available demographic
information (see Table 1). To test for differences
between the groups and their respective centers on
Adm Policy Ment Health & Ment Health Serv Res (2006) 33:398–409 399
123